Stephen Wonderlich (foreground) and his colleague James Mitchell are internationally recognized authorities in eating disorders research and treatment.

An eating disorders research team led by University of North Dakota researcher Stephen Wonderlich, director of clinical research at the Neuropsychiatric Research Institute (NRI), has developed a successful bulimia nervosa therapy that can provide patients an alternative for treating this debilitating disorder.

Wonderlich, a UND Chester Fritz Distinguished Professor of Neuroscience, says the new treatment is psychological in nature and focuses on eating- and emotion-related behavior through the arduous process of dealing with, and hopefully eliminating, their bulimic symptoms.

The therapy was developed over a period of more than 10 years with 80 patients treated in a randomized, controlled trial at NRI in Fargo and at the University of Minnesota's (UM) Department of Psychiatry in Minneapolis, with co-principle investigator Carol Peterson.

James Mitchell, Wonderlich's colleague at NRI and also Chester Fritz Distinguished Professor and chair of Neuroscience at UNDE, participated in developing this therapeutic treatment.

In a manuscript describing the research, the objective is described as comparing a new psychotherapy for bulimia nervosa--titled "Integrative Cognitive-Affective Therapy-- with an established treatment from England.

"In a scientifically controlled comparison with the treatment developed by Chris Fairburn at Oxford University, which is the most scientifically supported treatment available for adult individuals with bulimia nervosa, this new treatment performed comparatively well," said Wonderlich, who also is a partner with surgeon Luis Garcia at the Sanford Eating Disorders and Weight Management Center, Fargo.

"We had one of the lowest dropout rates in a scientific trial ever with this population," Wonderlich said. "In other words, just about everyone who started the trial completed the treatment."

Wonderlich said the trial was well-run with research teams at each site, Fargo and Minneapolis, and an evaluation team at the University of Wisconsin-Madison.

"When we did the scientific comparison, there was no difference between our treatment and the established treatment in terms of outcomes--they were comparable, or equal, in their efficacy," he said. "This is good news for the field because now there is another promising alternative treatment available which is a little different in nature than the Oxford treatment."

Bulimia nervosa is an eating disorder characterized by binge eating. Individuals with bulimia nervosa also engage in behaviors such as inducing vomiting and consuming laxatives. These behaviors may be followed by prolonged bouts of fasting, even though the person afflicted may be of normal weight. The term bulimia comes from a Greek word meaning "ravenous hunger, although the extent to which hunger actually motivates binge eating is unclear. Bulimia nervosa was first described by the British psychiatrist Gerald Russell in 1979.

"Basically, what we're trying to do is get people (with bulimia nervosa) to eat differently," Wonderlich said, "but you also have to look at the way they view the world and function in it. The Oxford treatment focuses on the bulimic individual's overvaluing of body shape and weight as well as dietary restriction, while our treatment focuses on eating behavior as well as what we would call emotional variables and relationship variables."

The NRI treatment is basically saying that emotional processes--feeling badly--are very important in triggering bulimic behaviors.

The treatment is based on research conducted with NRI colleagues Ross Crosby and Scott Engel in which patients used personal digital assistants such as the Palm Pilot, and subsequently, cell or smart phones to document their feelings and behaviors, a key part of the therapy.

"Basically, we're asking patients to report how they feel and observe the increase in negative emotions leading up to the behavior; what we want to know is what are things that make people feel badly, and then help them recognize that, and change their responses to those negative emotions," Wonderlich said.

Peterson, the UM-based principle investigator on this trial, is a research associate and assistant professor in the Department of Psychiatry and adjunct assistant professor in the Department of Psychology. Her research focuses on the assessment, diagnosis and treatment of eating and weight disorders.

Eating disorders, which are more prevalent in women than men, are very serious and sometimes fatal conditions. They include anorexia nervosa, characterized by self-starvation, intense fear of fat and gaining weight and body image disturbances; and bulimia nervosa, marked by binge eating behaviors accompanied by self-induced vomiting, laxative and diuretic abuse, fasting, or excessive exercise. Patients who suffer from these disorders have high rates of other psychiatric problems including major depression, anxiety disorders, substance use disorders and personality disorders, Wonderlich said.

Mitchell serves as president of the NRI and chair of the Department of Clinical Neuroscience at the UND School of Medicine and Health Sciences. Wonderlich is director of clinical research at NRI and associate chair of the Department of Clinical Neuroscience at the UND Medical School. Together they also work at the Sanford Eating Disorders and Weight Management Center. Both NRI and the Center are located in Fargo.